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Federal forms, ICRs, and supporting documents

Information Collection Request

IHS Forms To Implement The Privacy Rules (43 CFR Parts 160 and 164)

ICR 200303-0917-001 · OMB 0917-0030 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
6588 IHS Forms To Implement The Privacy Rules (43 CFR Parts 160 and 164) Migrated
ICR Details
0917-0030 200303-0917-001
Historical Active
HHS/IHS
IHS Forms To Implement The Privacy Rules (43 CFR Parts 160 and 164)
New collection (Request for a new OMB Control Number)   No
Emergency 03/31/2003
Approved without change 03/26/2003
Retrieve Notice of Action (NOA) 03/21/2003
  Inventory as of this Action Requested Previously Approved
09/30/2003 09/30/2003
542,500 0 0
174,375 0 0
0 0 0
This is a request for a new collection. This collection of information is made necessary b the DHHS Rule entitled "Standards for Privacy of Individually Identifiable Health Information" ("Privacy Rule") (456 CFR Parts 160 and 164). Considered a covered entity under the Privacy Rule, the IHS is subject to the Rule and must develop and implement methods to meet the information collection requirements contained in the rule.
None
None
No
1
IC Title Form No. Form Name
IHS Forms To Implement The Privacy Rules (43 CFR Parts 160 and 164)
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 542,500 0 0 542,500 0 0
Annual Time Burden (Hours) 174,375 0 0 174,375 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
03/21/2003